Year 2 Medical Student University of British Columbia Faculty of Medicine Vancouver, British Columbia, Canada
Background: Individuals who use/have used substances face healthcare barriers and may disengage with healthcare to avoid stigma or discrimination. Poorly worded or administered substance use screening by pediatricians could lead to retraumatization or judgment of caregivers that jeopardizes continued healthcare to the child. There is limited information in the literature regarding best approaches for pediatricians to screen caregivers for substance use. Objective: The objective of this review was to identify current methods for, approaches to, and acceptability of caregiver substance use screening in pediatric clinics. Design/Methods: Searches were performed in CINAHL, PsycInfo, MEDLINE, and Social Sciences Abstracts databases with results limited from 2000 to 2023. Keywords included “perinatal”, “postnatal”, “pediatric”, "substance* use/abuse", "alcohol use, "addiction", and “screening”. Studies must have been conducted in Canada, USA, Australia, or Scandinavia. Literature published in a language other than English, described screening using biological samples, or that screened pregnant caregivers was excluded. Three authors completed title, abstract, and full text screening in Covidence. Thematic coding identified studies' geographical setting, pediatric clinical setting, substances screened, participant characteristics, method of screening, and acceptability or outcomes of screening. Results: Practitioners used standardized and informal substance use screening tools. Pediatric providers reported gaps in guidance for screening caregivers for substance use and a desire for improvement. Lack of guidance made it uncomfortable to screen caregivers but increased comfort with screening when using a social needs survey. Caregivers were generally highly comfortable being screened and felt it was an acceptable action for pediatricians. However, the input of families in screening methods was lacking. Substance use questions were often paired with simple questions of acceptability while other studies simply used the openness of being approached or absence of objections as acceptance. None of the studies identified in this review included the ability for families to participate fully in screening acceptability or design.
Conclusion(s): Family engagement in research regarding the acceptability and design of screening methods is lacking while pediatric healthcare providers continue to be uncomfortable screening caregivers for substance use and wish for improved methods that facilitate trust with families. Further research into the design of trauma-informed caregiver substance use screening in pediatric settings may be needed.
